Updated 1 July 2021

Ulcerative Colitis – Symptoms, Diagnosis, and Treatment

Patient with stomach and upper abdominal pain from Ulcerative Colitis / Irritable Bowel Disease

Ulcerative Colitis - Symptoms, Diagnosis, and Treatment

 

What is Ulcerative Colitis?

Ulcerative Colitis is a chronic disease of the bowel. As the condition progresses, inflammatory changes and swelling begins to occur in the large intestine and the rectum.  Additionally, bowel and colon ulcers can also begin to develop.  Along with Crohn’s Disease, they are collectively grouped together as inflammatory bowel disease (IBD). Usually, the onset of this condition most often occurs in younger (18-30 years of age) and middle-aged adults (over the age of 50). In Australia alone, 75000 people have been diagnosed with IBD and is continuing to grow each year. 
 

Ulcerative Colitis Symptoms

Symptoms can generally vary and fluctuate. Those diagnosed with this condition can experience periods with or without symptoms. Flare ups of symptoms can occur randomly and vary in severity. Although unpredictable, the risk of flare ups can be reduced by taking the right medication and making the right lifestyle changes. Examples of common ulcerative colitis symptoms include (1):
  • Bleeding from the rectum which can be found in the stool or poo 
  • Abdominal cramping
  • Having the urge to go to the toilet frequently
  • Diarrhea 
  • Tenesmus or feeling that the bowels aren’t able to empty completely
Other less common symptoms can also involve weight loss, fatigue and loss of appetite.
 

Ulcerative Colitis Causes

Researchers have found that inflammatory changes to the inner lining of the bowel of those diagnosed with ulcerative colitis and irritable bowel disease. Although, no one is currently certain about what causes inflammation in the colon and bowel. 

Genetics

There are suggestions that genetic factors are the most significant contributors to the development of ulcerative colitis. Those with an immediate family member who happens to have this condition are up to 4-times more likely to also have it (2).

Immune Problems

Researchers have also indicated that this condition is caused by autoimmune problems (3). When this occurs, the immune system begins to wrongfully attack the healthy colon and bowel tissue.

Other Factors

Environmental factors have also been shown to increase the risk of developing inflammatory bowel disease and ulcerative colitis. Smoking, drugs, infections, exposure to pollution and a poor diet have also been shown to contribute to inflammatory changes in the bowel (4)
 

Ulcerative Colitis Diagnosis and Tests

Many of the symptoms seen in ulcerative colitis are similar to other gastrointestinal diseases, such as Clostridium difficile and Crohn’s Disease. Promptly seeing your GP will be important for being diagnosed accurately. By receiving a proper diagnosis, appropriate treatment can be started early to prevent flare-ups and worsening of the condition. Tests that your GP may recommend, includes:
  • Comprehensive medical and physical assessment
  • Stool and faecal testing
  • Ulcerative Colitis colonoscopy examination
  • Less common test include: magnetic resonance imaging (MRI), CT scan and blood tests

Ulcerative Colitis vs Crohn’s Disease

Given the similar presentations between these two conditions, they can often be mistaken for each other. However, experienced GPs will be able to use specific tests to identify the differences between Ulcerative Colitis and Crohn’s Disease. Mainly, the differences lie within the location of the inflammatory changes of the bowel.
 

Does Ulcerative Colitis Spread? Is it Contagious?

Some types of colitis or inflammation of the colon can be spread to others through viruses and bacteria. However, ulcerative colitis is not contagious and cannot be spread from human-to-human. 
 

Ulcerative Colitis Treatment

Treatment of this condition will vary person-to-person depending on several considerations, such as symptoms (e.g. bleeding in the stool, frequency of bowel movements, etc.), the condition’s severity and the day-to-day impact of the condition. Consulting an experienced GP will be important for developing strategies to manage symptoms, prevent flare ups and reduce the likelihood of potentially serious complications (please refer to ‘Complications’ section below).  Examples of treatments that your GP may recommend, include: 

Ulcerative Colitis Medications

Certain medications (5) prescribed from doctors aim to reduce symptoms and inflammation. Drugs and therapies that may be considered include aminosalicylates, thiopurines, corticosteroids, antibody therapies and immunosuppression.

Dietary Changes 

Eating an appropriate diet is crucial for preventing and managing flare-ups. Unfortunately, there is no ‘one size fits all’ diet as everyone with the condition will react to certain types of foods differently. Speaking to a dietitian, doctor and/or nutritionist should be considered. Discussions about approaches to meal plans and foods to avoid with ulcerative colitis should be commenced as soon as possible. For instance, smaller and more frequent meals (4-6 times/day) should be considered to promote healthy digestive practices (6).  For some people, supplementation may also be required due to the body’s inability to properly absorb nutrients. 

Stress management

A stressful lifestyle can trigger flare ups due to its negative impact on the immune system and association with inflammation. Developing strategies with your GP to help with stress may be worthwhile. Some suggestions can include: seeing a psychologist, joining an IBD support network, meditation,exercise, and  talking to friends and family (7)

Other lifestyle changes

Maintaining a healthy lifestyle can help with lowering the risk of flare ups. Examples of strategies that you can discuss with doctors include changing smoking habits, regular physical activity, reducing alcohol, sleeping sufficiently, etc.

Surgery

Whilst most people can manage their ulcerative colitis with medications and changes in their lifestyle, very few may require surgery. Those with sudden and uncontrollable symptoms or a perforated colon need to seek a medical opinion immediately. Referrals may be made to a gastroenterologist specialist if required. Common surgical procedures that are performed include ileostomy, colectomy and proctocolectomy.  
 

Recovery

Ulcerative Colitis is a chronic and lifelong condition. Currently, there is no cure. The main purpose of treatment is to prevent flare-ups and the condition worsening. Being proactive by regularly seeing your GP and adopting healthy  lifestyle habits can be beneficial for maintaining or improving quality of life. 
 

Complications

With early and appropriate treatment, many people diagnosed with ulcerative colitis can live long productive lives. During periods of remission, symptoms may be mild or not be present at all. However, some people can develop long-term complications due to the ongoing inflammatory changes in the bowel, such as:
  • Osteoporosis (due to long-term corticosteroid use)
  • Nutritional deficiencies leading to issues, such as malnutrition and underdevelopment in children
  • Toxic megacolon which can be a life-threatening complication where gas is trapped in the colon.
  • An increased risk of bowel cancer which requires regular medical monitoring. 
  • Incontinence
  • Impaired sexual function
   

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References

  1. Rubin, D. T., Ananthakrishnan, A. N., Siegel, C. A., Sauer, B. G., & Long, M. D. (2019). ACG clinical guideline: ulcerative colitis in adults. American Journal of Gastroenterology, 114(3), 384-413. 
  2. Lynch WD, Hsu R. Ulcerative Colitis. [Updated 2020 Jun 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459282 
  3. https://www.benaroyaresearch.org/what-is-bri/disease-information/crohns-and-colitis 
  4. Abegunde, A. T., Muhammad, B. H., Bhatti, O., & Ali, T. (2016). Environmental risk factors for inflammatory bowel diseases: Evidence based literature review. World journal of gastroenterology, 22(27), 6296.
  5. Feuerstein, J. D., Isaacs, K. L., Schneider, Y., Siddique, S. M., Falck-Ytter, Y., Singh, S., ... & Terdiman, J. (2020). AGA clinical practice guidelines on the management of moderate to severe ulcerative colitis. Gastroenterology, 158(5), 1450-1461.
  6. https://www.crohnscolitisfoundation.org/diet-and-nutrition/what-should-i-eat 
  7. https://www.crohnscolitisfoundation.org/sites/default/files/2019-07/managing-flares-brochure-final-online.pdf 
  8. Lamb, C. A., Kennedy, N. A., Raine, T., Hendy, P. A., Smith, P. J., Limdi, J. K., ... & Hawthorne, A. B. (2019). British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults. Gut, 68(Suppl 3), s1-s106.
  9. Pudipeddi, A., Liu, J., Kariyawasam, V., Borody, T. J., Cowlishaw, J. L., McDonald, C., ... & Leong, R. (2021). High prevalence of Crohn disease and ulcerative colitis among older people in Sydney. Medical Journal of Australia.
  10. https://www.nhs.uk/conditions/ulcerative-colitis/complications/